Out-of-hours maxillofacial trauma surgery: a risk factor for complications?

Abstract

Recent literature from general and orthopaedic surgery as well as anaesthetic viewpoints has identified that operations performed outside normal work hours pose potential risks for both patients and healthcare workers. This is in contrast to the increasing pressure for 24h surgical availability for the public and the desire to reduce waiting times for patients. Further, there is evidence of the effects of fatigue on reducing performance. The authors aim to compare outcomes of maxillofacial trauma surgery performed in and out of normal work hours. Retrospective analysis was carried out on all maxillofacial trauma surgery under general anaesthesia at a tertiary referral hospital over a 14-month period. Outcomes of patient mortality, injury severity, patient demographics and operation duration were analysed with reference to two groups: in-hours (0800-1700 Monday to Friday) and out-of-hours (1700-0800 Monday to Friday as well as all operations performed Saturday and Sunday). 134 patients/procedures met the inclusion criteria, 53 out-of-hours and 81 in-hours. A statistically significant (p=0.05) higher complication rate (13%) was found in the out-of-hours cases compared to the in-hours cases (4%). The potential implications for this result on the need for increased availability of dedicated in-hours maxillofacial trauma operating lists at major hospitals are discussed.

Risk factors for surgical site infection following laparotomy: Effect of season and perioperative variables and reporting of bacterial isolates in 287 horses

“…In the latter study, patients were at increased risk of SSI when surgery was undertaken during the summer and autumn months. Surgery performed outside normal working hours has also been reported to result in higher post operative complication rates in both human and equine studies compared to those performed within normal working hours . The effects of season and surgery being performed outside normal working hours have not been investigated as risk factors for SSI following laparotomy in horses.…”

Is there an optimal timing for surgical treatment of pediatric supracondylar humerus fractures in the first 24 hours?

“…In the literature, there are some studies investigating the optimal surgical timing in other trauma fields besides SHFs and they reported higher complication rates during cases performed at night [ 12 – 14 ]. However, we have reported similar operative parameters on pediatric SHFs operated in the daytime (08.00-17.00) or nighttime (17.00-24.00) and late nighttime (24.00-08.00).…”

Improving hand surgery access and care through service redesign

“…Operating outside normal working hours possesses an increased risk to the patient and the surgeon. Patients undergoing non‐emergent surgical operations after hours have an increased risk of post‐operative complications in high‐volume surgical specialties …”